Advances in Antiarrhythmic Drug Therapy: New and Emerging Therapies

Despite major advances in the nonpharmacologic therapy for arrhythmias in the past decades, there is still a substantial role for antiarrhythmic drugs especially in the treatment of atrial fibrillation and ventricular tachycardia, the most effective of which is amiodarone. Dronedarone has been developed by modifying the amiodarone molecule, thus retaining its multichannel blocking action while still reducing its toxicity. New potassium channel blockers such as vernakalant are currently under development for the treatment of atrial fibrillation and flutter. So-called upstream therapies such as renin-angiotension system antagonists, statins, and n-3 polyunsaturated fatty acids offer promise for the treatment of antiarrhythmia. This article reviews dronedarone, which is already approved and available; antiarrhythmic agents that are the most advanced in development; and upstream therapy for atrial fibrillation.